Yano 2021.

Study characteristics
Methods	Study characteristics Study design: parallel RCT Study duration: November 2015 to June 2016 Study follow‐up: 3 months
Participants	Baseline characteristics Country: Japan Setting: university hospital (1 site) Inclusion criteria: stable HD patients; > 20 years; ESKD undergoing HD; carnitine deficiency, defined as having both free carnitine levels < 36 μmoL/L, and acylcarnitine free/carnitine ratio < 0.4 Randomised number (intervention group/control): 10/10 Dialysis modality: HD Mean age ± SD (years): intervention group (57.1 ± 11.1); control group (53.9 ± 16.5) Sex (M/F): intervention group (6/4); control group (6/4) Dialysis duration: not reported Exclusion criteria: contraindications for L‐carnitine; pregnant women, or those possibly pregnant; patients deemed inadequate by a physician; or those suffering from symptomatic CVD or musculoskeletal disorders interfering with exercise training
Interventions	Intervention group L‐carnitine (IV): 1000 mg at each dialysis session for 3 months Control group Cycle ergometer exercise during HD sessions
Outcomes	Outcomes relevant to this review Muscle weakness: 10‐minute walk test, chair‐stand test Anaemia‐related markers: Hb
Notes	Funding source: a Grant‐in‐Aid for Welfare and Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan. One of the authors has received honoraria, including lecture fees, from Otsuka Pharmaceutical Co., Ltd
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "randomly assigned using simple randomization procedures (computer‐generated list of random numbers) "
Allocation concealment (selection bias)	Low risk	Quote: "the allocation was concealed by finishing the randomization"
Blinding of participants and personnel (performance bias)	High risk	Quote: "open‐label" study
Blinding of outcome assessment (detection bias) Muscle symptoms	High risk	Quote: "open‐label" study
Blinding of outcome assessment (detection bias) Anaemia‐related markers	Low risk	The outcome measurement is not likely to be influenced by lack of blinding
Incomplete outcome data (attrition bias) Muscle symptoms	Low risk	All patient outcome data reported
Incomplete outcome data (attrition bias) Anaemia‐related markers	Low risk	All patient outcome data reported
Selective reporting (reporting bias)	Low risk	Pre‐specified outcomes of interest to this review were reported
Other bias	High risk	Funding source: a Grant‐in‐Aid for Welfare and Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan. One of the authors has received honoraria, including lecture fees, from Otsuka Pharmaceutical Co., Ltd